Perry, Cruz, Cornyn to fight Medicaid expansion

Gov. Rick Perry and Texas' two U.S. senators will join forces at the state Capitol on Monday to reassert their opposition to expanding Medicaid, a central tenet of federal health reform that has been a subject of much debate among state lawmakers on both sides of the aisle.

The details of the Monday morning press conference, which will also include representatives from the Texas Public Policy Foundation (TPPF), a conservative think tank, are still being worked out. But a source involved in planning the event who wasn't authorized to announce it said Perry and Sens. Ted Cruz and John Cornyn will stand together to demand greater flexibility from the Obama administration to operate the state's existing health care system for poor children and the disabled as Texas sees fit.

In a report released last week, TPPF suggested that Texas, which currently spends a quarter of its budget on Medicaid, could use a federal block grant to cut costs and fundamentally reform the program without expanding it. The group's proposal includes using those federal block grant dollars to subsidize private health savings accounts so Medicaid recipients could manage and pay for their own health services.

Perry's own desires for Medicaid reform closely mirror TPPF's plan, and include a system of co-pays, deductibles and premium payments on a sliding scale for poor patients, using asset testing to ensure services are going to people who truly need them.

Although many Republican lawmakers have called for such a block grant, most acknowledge that Texas is unlikely to receive one — especially if there are no strings attached that require a Medicaid expansion. Texas has the country's highest uninsured rate, and the federal government would like the state to draw far more of its poor adults into the Medicaid program.

And the jury is far from out at the state level on whether or not to negotiate with the federal government to seek ways to expand Medicaid. Billy Hamilton, the state’s former chief revenue estimator and former deputy state comptroller, has estimated that expanding Medicaid would cost Texas $15 billion over 10 years, while allowing the state to draw down $100 billion in federal financing. That's a tempting sum — one that not all Texas Republicans are sold on passing up.

Cruz and Cornyn appear to be. Since arriving in Washington, Cruz has made good on his campaign promise, filing legislation to repeal the federal Affordable Care Act. Last week, that measure was voted down on a party-line vote.

Earlier this month, Cornyn co-sponsored a Cruz amendment to the Senate's Democratic budget proposal that would've defunded the Affordable Care Act; that effort also failed.